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Introduction: Optimal treatment of recurrent papillary thyroid carcinoma (PTC) in children remains controversial. We reviewed our experience with recurrent PT C to better identify children diagnosed with it. Aims: The objective of this stu dy was to determine the risk factors, optimal treatment, complications, and prog nosis of recurrent PTC in children. Methods: This is a retrospective review of a ll thyroid resections for children aged 18 years or younger who have PTC at a si ngle institution from 1987 to 1999. Results: Thirty-six children, 7 boys (19%) and 29 girls (81%), underwent initial cervical exploration for PTC. Lymph node involvement was noted in 25 patients (69%); however, there was no distal disea se. An equal number of children underwent subtotal thyroidectomy (n = 18) and to tal (n = 18) thyroidectomy as their initial operation. Papillary thyroid carcino ma recurrences developed in 17 patients (47%) a median of 7 months (range, 1-4 3 months) after their initial operation. Recurrence was more common for patients with lymph node involvement (P < .01) and multiple nodules (P < .05) at present ation. Recurrence developed in 5 patients after subtotal thyroidectomy and in 12 patients after total thyroidectomy. Sixteen children with recurrent PTC had a s econd operation and 6 required a third operation. Total operative complications included 2 patients with permanent hypocalcemia and 1 patient with permanent rec urrent laryngeal nerve injury, all of whom had a total thyroidectomy. No patient died; however, 3 continue to harbor disease. Mean follow-up for patients with PTC was 65 months (range, 15 to 144 months). Conclusions: Thyroid resection comb ined with selective use of radioactive iodine ablation is a safe and effective t reatment for recurrent PTC in children. The best predictors of this recurrent di sease are lymph node involvement and multiple thyroid nodules at presentation.